Guideline group turns gaze to opioid epidemic

(Reuters Health) – – As the opioid epidemic deepens, a government-backed panel that routinely draws up guidelines for disease prevention is starting to search for ways to prevent addiction to these drugs in the first place.

The United States Preventive Services Task Force (USPSTF) has drafted a plan for research to identify evidence-based strategies that could lower the likelihood of addiction developing out of opioid prescriptions.

“This is a new preventive service we’re looking at,” said Dr. Alex Krist, a professor of family medicine at Virginia Commonwealth University and USPSTF vice-chair. “And we’re proposing to evaluate evidence around that preventive service. We’re looking for public input as we want to make sure we’re looking at the right kinds of evidence.”

The effort comes as the National Institute for Drug Addiction estimates that more than 115 people die each day from opioid overdoses in the U.S. alone.

The draft focuses on strategies that can be implemented in primary care settings to reach teens and adults with short-term or chronic pain who are not currently using opioids. The panel hopes to settle on a list of interventions that can then be researched for evidence of success.

“As opposed to asking if patients are misusing drugs like opioids, we’re now trying to see if there are . . . things that can be done to prevent patients from getting to the point where they misuse opioids,” Krist said.

Special attention would be focused on groups believed to be particularly vulnerable, such as those with mental health problems along with pain, and those with prior histories of substance use disorders.

Interventions focus mostly on education about opioids. But there is also a category for assessing the risk of opioid misuse in patients who might be prescribed opioids for pain.

While pain management experts welcomed the new effort, they were surprised at the lack of attention focused on alternatives to opioids.

“In general, the idea is a very good one,” said Dr. Ajay Wasan, a professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine and vice chair for pain medicine at the University of Pittsburgh Medical Center. “Their plan is to look at strategies to decrease the chances that patients who are prescribed opioids will become addicted. But what they are including is only education-based interventions. There are all kinds of non-opioid treatments that could have the outcome of preventing patients from becoming addicted.”

“They really need to expand the scope of what they are doing,” Wasan said. “There is literature on non-opioid options to manage pain around the time of surgery and decreasing exposure during the peri-operative period. But we don’t know what works and what doesn’t. We need systematic reviews.”

Dr. Eellan Sivanesan would agree. “We all realize that there is a problem with opioids,” said Sivanesan, of the division of pain medicine in the department of anesthesiology and critical care medicine at the Johns Hopkins School of Medicine in Baltimore. “But people are still going to have pain. We need alternative treatments for pain. Part of that is increasing access to the variety of pain treatments that are available.”

A review that resulted in new guidelines might help patients avoid opioids if the guidelines recommend alternative treatments, Sivanesan said. Currently, he said, “it’s becoming increasingly difficult to get those kinds of treatments authorized by insurance providers. For example, it’s a lot easier for me to prescribe opioids than some of the more costly neuropathic pain medications available.”